Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study
Authors: Julie Woodfield, Ingrid Hoeritzauer, Aimun A.B. Jamjoom, Josephine Jung, Simon Lammy, Savva Pronin, Cathal J. Hannan, Anna Watts, Laura Hughes, Richard D.C. Moon, Stacey Darwish, Holly Roy, Phillip C. Copley, Michael T.C. Poon, Paul Thorpe, Nisaharan Srikandarajah, Gordan Grahovac, Andreas K. Demetriades, Niall Eames, Philip J. Sell, Patrick F.X. Statham, Mohamed Abdelsadg, Motaz MS Abulaila, Usman Ahmed, Qasim Ajmi, Rafid Al-Mahfoudh, Chadi Ali, Meriem Amarouche, Amin Andalib, Mohit Arora, Mukul Arora, Mariam Awan, Asfand Baig Mirza, Antony Bateman, Iwan Bennett, Imran Bhatti, Peter Bodkin, Lalasa Bommireddy, George Bonanos, Anouk Borg, Alexandros Boukas, James Bourne, Rachael Brennan, Jennifer Brown, Katie Brown, Oliver Burton, Christopher Busby, Neil Chiverton, Simon Clark, Phillip C Copley, Simon Cudlip, Yan Cunningham, Ronan Dardis, Stacey Darwish, Benjamin Davies, Andreas K Demetriades, Saurabh Deore, Chris Derham, Muhammad Dherijha, Gareth Dobson, James Duncan, Andrew Durnford, Alexander ZE Durst, Edward W Dyson, Niall Eames, Ellie Edlmann, Andrew Edwards-Bailey, Anne Elserius, Becca Elson, Mohammed Fadelalla, Daniel M Fountain, Adrian Gardner, Arnab Ghosh, James R Gill, Stella A Glasmacher, Robin Gordon, Gordan Grahovac, Rebecca Grenfell, Awais Habeebullah, Nikolaos Haliasos, Tim Hammett, Cathal John Hannan, Ciaran Scott Hill, Ingrid Hoeritzauer, David Holmes, Kismet Hossain-Ibrahim, Laura Hughes, Muhammad Hussain, Shakir Hussain, Ramez Ibrahim, Aimun AB Jamjoom, Bethan John, Shabin Joshi, Josephine Jung, Oliver Kennion, Muhammad Khan, Adriana Klejnotowska, Ashwin Kumaria, Roberta LaCava, Simon Lammy, Alistair Lawrence, Matthew Lea, Andraay HC Leung, Ignatius Liew, Weisang Luo, Oscar MacCormac, James Manfield, Richard Mannion, Joseph Merola, Pranav Mishra, Khalid Abubaker Mohmoud, Richard Moon, Rory Morrison, Odhran Murray, Ali Nader-Sepahi, Colin Nnandi, Anand Pandit, Nitin Patel, Anita Philip, Michael TC Poon, Kuskoor Seethram Manjunath Prasad, Savva Pronin, Shyam Pujara, Balaji Purushothaman, Kapil Rajwani, Fahid Tariq Rasul, Holly Roy, Ahmed-Ramadan Sadek, Moritz Schramm, Gabrielle Scicluna, Philip J Sell, Roozbeh Shafafy, Himanshu Sharma, Asim Sheikh, Vinothan Sivasubramaniam, Agbolahan Sofela, George Spink, Nisaharan Srikandarajah, Patrick FX Statham, Stuart Stokes, Euan Strachan, Chrishan Thakar, Gopiga Thanabalasundaram, Paul Thorpe, Christian Ulbricht, Anna Watts, Alison Whitcher, David White, Kathrin Whitehouse, Martin Wilby, Julie Woodfield, Ardalan Zolnourian
Journal: The Lancet Regional Health - Europe (2022)

Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.